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MS in Pregnancy — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS in PregnancySCE Neurology

A 38-year-old woman with RRMS controlled on dimethyl fumarate wishes to conceive. What is the most appropriate advice regarding her DMT?

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Correct answer: A — Stop dimethyl fumarate at least 1 month before conception and manage with monitoring

Dimethyl fumarate should be discontinued before conception (at least 1 month washout). Natalizumab is the only high-efficacy DMT with evidence supporting continuation during pregnancy when the risk of relapse is high. For most women, stopping DMT before conception with close monitoring is appropriate. A: Dimethyl fumarate is not recommended in pregnancy. B: Switching to natalizumab is an option for high-risk patients but is not the default approach. D: Abrupt cessation without planning risks rebound. E: Fingolimod is contraindicated in pregnancy (teratogenic) and requires a 2-month washout.

Reference: NICE TA533; ABN MS Guidelines (2022); MHRA Safety Advice on AEDs in Pregnancy